Multitarget Pulse Field Ablation Guided by Endocardial and Non-invasive Atrial Driver Mapping (PFA+ADM) Pilot Study. Development of an Ablation Strategy to Improve the Efficacy of Long Standing Atrial Fibrillation Ablation in Patients With High Comorbidity Burden or Heart Failure

Inclusion Criteria: * Age between 18 and 80. * Ability and willingness to follow the study protocol, including informed consent. * Symptomatic long-standing AF for at least one month, documented by ECG or dual-chamber device recordings. * History of failure, intolerance, or refusal of antiarrhythmic drug therapy. * New York Heart Association (NYHA) functional class II or III, or left ventricular dysfunction (LVEF ≤ 50%) or a CHA2DS2-VASc score of 4 or more. * Optimal medical treatment for heart failure for at least three months for patients with left ventricular dysfunction. Exclusion Criteria: * Left atrial diameter \>5.5 cm. * Previous left atrial ablation or surgery. * Lack of anticoagulation therapy for 3 weeks prior to the procedure. * Pulmonary vein stents or stenosis. * Pre-existing diaphragmatic paralysis. * Cardiac valve prosthesis or significant valve disease. * Recent cardiac surgery or interventions within the past 3 months. * Unstable angina, NYHA Class IV heart failure. * Pulmonary hypertension or rheumatic heart disease. * Blood clotting disorders. * Contraindications to chronic anticoagulation. * Active infection or hypertrophic cardiomyopathy. * Reversible causes of AF, such as hyperthyroidism or sleep apnea. * Stroke or TIA in the past 6 months. * History of thromboembolic events or evidence of intracardiac thrombus. * Women of childbearing age * Life expectancy less than 12 months. * Participation in another clinical trial. * Allergy to adhesives. * Inability to comply with study procedures. * Inability to provide personal consent. * NYHA Class IV heart failure. * Left ventricular ejection fraction ≤ 25%.